Primary Care Case Studies

Case Study 1

Ross Raymond-Jones

When did you qualify? How long have you worked in your current trust/general practice?

I qualified as a physician associate (PA) in 2019 where I entered directly into secondary care at Derriford hospital in Plymouth. Here I spent a year rotating through departments including endocrinology, a short stay general medical ward and healthcare of the elderly.


Where do you work now and a brief overview of your job role.

I currently work as a Health Education England (HEE) PA ambassador and clinical lecturer at Plymouth University. This is a varied role which involves working in different settings. The majority of my time is spent rotating through general practices across Devon and Cornwall showcasing the professions role in primary care. The rest of my time is dedicated to south west based HEE projects and teaching on the Plymouth PA programme.


What was your background before becoming a PA?

My undergraduate degree was in adult nursing. Having heard about the PA course during my nurse training I was torn between pursuing a career as an advanced nurse practitioner or the path less trodden, as a PA. After a few months working as a nurse in an emergency department and after much research I decided to enter PA training. My nursing background and exposure to clinical environments provided me with a good foundation for this training and I’m proud to still hold an NMC pin. I’m confident that joining the PA profession was that right choice for me and I’ve not looked back since.


Your favourite part about being a PA/ what you think PA's bring to the team.

My favourite part about being a PA is being part of a new and upcoming medical profession. This can put many people off, but for me it's one of the main reasons I joined. As a new profession you get to be at the forefront on its development and even influence its future. It's exciting to know that the future of the profession is not yet set in stone and that there will likely be roles for us that may not even exist yet. Not only this, but as a PA there are present opportunities that traditional professions are unable to offer - such as my current job role. Each PA brings something different to their team based on their previous expertise and experience. What's brilliant is that they are generalists and are therefore adaptable to meet the needs of whatever team they find themselves in.


The main challenge/barrier you face as a PA.

The universal challenge the profession currently faces is identity and regulation. Being unregulated puts legal restrictions on important medical powers such as prescribing and requesting ionising radiation. Fortunately, the GMC have agreed to be our regulatory body and my hope is as this transition takes place we are able to use it to form a stronger and universal professional identity.


Case Study 2

Georgie Smith

When did you qualify? How long have you worked in your current trust/general practice?

Newly qualified in October 2020. Began my job in general practice on the 2nd of November 2020.


Where do you work now and a brief overview of your job role.

I am employed by Devizes primary care network – consisting of 4 surgeries - but am currently attached to St James Surgery. As I have only recently started employment a lot so far has been getting to grips with the practice and the way it works. After completing the induction period, I have become more independent and now aid the duty doctor in picking up the telephone triage list, seeing some of these patients face to face in the afternoon. I also do a ward round at a local care home on Mondays and have Physician Associate teaching on a Tuesday afternoon. I have been actively involved in the rollout of the COVID vaccination programme. In the new year, I hope to take on my own patient list and set up a chronic disease clinic in an area of interest to me.


What was your background before becoming a PA?

Prior to becoming a PA I did a Biological Sciences BSc at UWE, where I then stayed to complete the PA MSc. During my final year of my undergraduate degree and the two years of the PA course I worked in admin in A&E at Southmead hospital in order to gain some healthcare-related experience. It was an incredibly valuable 3 years.


Your favourite part about being a PA/ what you think PA's bring to the team.

Being a PA in general practice gives me a great level of responsibility whilst still feeling heavily supported by the team/my supervisor. Being the first PA at the practice has also given me the ability to shape my role to how I want to work and how the practice needs me, as well as being able to take on clinics/audits in areas I have interest in. I think PAs provide a level of continuity that junior doctors can’t provide due to their training and rotations – I think this is a real benefit for patients and equally for work/life balance for me. I also like that if in several years I decide I want a change from primary care, I don’t have to retrain and have the fluidity to move to a different specialty.


The main challenge/barrier you face as a PA.

I think for now the main barrier is still that patients and indeed other staff members are still unsure of the abilities of a PA – there is a lot of confusion about whether we are doctors or nurses or neither. I think this is something that will not be an issue in years to come as we become more known. The other challenge is waiting for regulation and prescribing rights. Luckily working in primary care there are ways in which to bypass the prescribing issue, such as by getting a doctor to oversee and sign any prescriptions. Overall although not a huge problem it will be much smoother once these regulations are passed.


Case Study 3

Sarah Bruce

When did you qualify? How long have you worked in your current trust/general practice?

Qualified in November 2019 – worked in General Practice since November 2019.


Where do you work now and a brief overview of your job role.

I currently work in a GP surgery in a town in Wiltshire. I work 5 days a week with a diverse rota alongside the doctors from diabetes clinics, taken the lead on learning disability reviews, helping with triage, undertaking the local nursing home round and routine general appointments.


What was your background before becoming a PA?

I studied a Neuroscience Degree at University of Nottingham and knew I didn’t want to go down the research route. I wanted a career that was people orientated and applied science. I had done volunteering on a geriatric ward in the University Hospital in my final year and realised a career in medicine was my passion. The Physician Associate course looked great as it has a lot of hours on placement whilst still having a large amount of time in lectures going over biology and pharmacology.


Your favourite part about being a PA/ what you think PA's bring to the team.

My favourite part about being a PA is actually the dependent part of our job role as it creates a good working relationship with your supervising doctor and time to discuss cases and learn from their wisdom and knowledge. In our practice I feel the PA role has bought flexibility to their workforce, because we are generalists I have been able to help other teams within the practice, I do routine work alongside the doctors, I have helped cover for the advanced nurse practitioners on triage and I have done phlebotomy clinics to help when staff were off sick so we didn’t fall behind in blood test appointments.


The main challenge/barrier you face as a PA.

The main challenge I face is people not knowing what a Physician Associate is and being called a nurse or doctor but with enough interest, and an ever evolving succinct explanation, the patients at our practice are understanding my role and what is within my scope of practice.


Case Study 4

James Willis

When did you qualify? How long have you worked in your current trust/general practice?

I studied at UWE Bristol from 2016-2018. I graduated with a distinction at master’s level in autumn 2018 and passed my national exam in autumn 2018. I have been working in primary care for over a year now having spent my first 12 months as a PA in secondary care.


Where do you work now and a brief overview of your job role.

I now work for The Crest Family Practice at Knowle West Health Park in South Bristol. I work as part of a multidisciplinary team consisting of GPs, nurse practitioners, physiotherapists, and healthcare assistants to deliver holistic clinical services and person-centred care in a primary care setting.

As part of the new model of working in primary care during Covid-19, I conduct a morning and afternoon surgery four days per week, working as part of the medical team remotely triaging and, if clinically needed, seeing acute on-the-day and pre-booked routine patients face-to-face.

Most recently, I have worked alongside GPs and nurse practitioners as part of the Covid-19 vaccination team. My role involved managing the cold-chain and session stock for the Pfizer Biotech vaccine.


What was your background before becoming a PA?

I studied BSc Hons Biomedical Science at UWE Bristol from 2011-2014. I graduated with a 2:1 and then went on to work as an Associate Practitioner in Histopathology in the pathology laboratory at Weston General Hospital, in Weston-Super-Mare.

I first learned about the PA role from Miss Michelle Mullan, Consultant in Oncoplastic Breast Surgery, who was my mum’s surgeon. I knew the role ticked all the right boxes for me and once the program launched at UWE Bristol, it was an easy decision to apply.


Your favourite part about being a PA/ what you think PA's bring to the team.

My favourite thing about being a PA is the clinical versatility and flexibility to shape your own career. In the two years since I have qualified, I have already spent 12 months working on a hyper acute stroke unit in secondary care and spent over a year working in primary care. I have also visited various universities around the country to teach student PAs, which I have also really enjoyed.

I think PAs bring a broad range of skills to the team and can be adapted/upskilled to meet both their own developmental needs and those of the team within which they are working.


The main challenge/barrier you face as a PA.

I believe the main challenges/barriers that I face as a PA have mostly arisen due to a lack of prescribing rights. I feel that establishing a lasting, trusting professional relationship between the PA and their supervising clinician enables an efficient workaround to this issue, but this is largely dependent on the department within which the PA finds themselves.

In my experiences in secondary care, where consultants may change on a week-by-week basis, and junior doctors rotate seasonally, I feel it was more difficult to establish that relationship due to the lack of continuity between the PA and their supervising clinician/junior doctor colleagues. Whereas in primary care, it has been easier to foster strong working relationships by ensuring shared shift patterns with my designated clinical supervisors and encouraging remote or digital mentoring where appropriate.

I also believe a transition to a purely digital portfolio would improve record keeping for clinical learning events and activities.

Case Study 5

Paul Madden

When did you qualify? How long have you worked in your current trust/general practice?

I qualified at the end of 2018 and went straight into General Practice. I have worked in my current practice since May 2020 and as an Ambassador since August 2020.


Where do you work now and a brief overview of your job role.


I currently have two roles-

1) PA at St Austell Healthcare working part time over four days. Here I work at the Health Hub triaging and seeing acute patients.

2) PA Ambassador with Kernow Health Training Hub, promoting and supporting the role through General Practice in Cornwall.


What was your background before becoming a PA?

Undergraduate degree in Law.


Your favourite part about being a PA/ what you think PA's bring to the team.


- Being able to do a job that I enjoy

- Home / work life balance

- Being able to choose an area of medicine straight after qualification

- The flexibility of being able to change direction at any point in your career

- A desire to be involved and shape a new profession



The main challenge/barrier you face as a PA.


- Not being a formal national career structure


How have PAs impacted your surgery?